InMindOut Blog

Written by Ashley A. Bono, LPC, LMFT

  In the course of my clinical career as a therapist, I’ve seen many people present with different mental health diagnosis. By far one of the most perplexing mental health problems that I have worked with is self harm. Since I work mainly with children and adolescents, the problem of self harm is one that I come across on occasion. Each time a case of self harm presents itself, the following questions tend to come up: How did this happen? What made my child decide to hurt themselves? How do I respond to my child wanting to injure themselves? How do I get them to stop? While there is no clear cut answer to these questions, many professionals have undertaken the tremendous task of researching possible reasons behind the self harming behaviors. Listed below are some of the reasons that researchers have so far uncovered when it comes to self injury.

1. Low Emotional Affect. Whenever I ask young people why they tend to cut or try any form of self injury, the most common answer that I get is that they want to feel something. Many individuals who self injure tend to feel numb, or feel like their emotions are not working very well. Self harm tends to kick start an emotional response by putting the individual’s primary focus on the pain that the injury has (Hooley, J.M., & Franklin, J. C., 2018).

1. An increased desire to punish self. Many individuals who have self harming behaviors primarily do so with the idea to punish themselves for a perceived slight or wrong (Hooley, J.M., & Franklin, J. C., 2018). This is especially true in cases where the individual has undergone extensive trauma (Hooley, J.M., & Franklin, J. C., 2018).

1. Increased attention from others. While some individuals self injure to punish themselves, other do so in order to gain attention from loved ones or peers (Hooley, J.M., & Franklin, J. C., 2018). Because of the serious nature of self injury, the individual may get extra attention from people that they usually don’t get attention from due to the fact that they are deliberately putting themselves in a potentially dangerous situation (Hooley, J.M., & Franklin, J. C., 2018).

1. A desire to fit in. Believe it or not, individuals that self injure can be heavily influenced by peers that tend to self injure. Individuals who self injure often have a hard time making healthy connections with others, which drives them to be attracted to those who tend to show the same negative behaviors (Hooley, J.M., & Franklin, J. C., 2018).

While the possible reasons for self injury may vary there is one question that has yet to really be fully answered: How do we treat self injurious behavior? Some researchers agree that it is important to treat the self injury at its very source: an unbalanced mindset (Hooley, J. M., & St. Germain, S. A. (2014). Many individuals who self injure have a low self esteem to begin with, so it is essential to help the individual see the value that they possess as human beings in order to effectively treat the self injurious behaviors (Hooley, J. M., & St. Germain, S. A. (2014). It is also important to help the individual find healthy ways to cope with pain and activate a positive emotional response besides going for razor blade (Hooley, J. M., & St. Germain, S. A. (2014).

If you’re the parent of a child or teenager who has self injured or is currently self-injuring, you may be wondering what my role as a parent in all this is. First and foremost self injury is a sign of deep emotional pain. It does not necessarily mean that you’ve been a terrible parent or have not been there for your kids. In fact, there are times when kids tend to cut as a result of not getting too much support at school or in other environmental areas. This problem, however, requires extra vigilance on your part as a parent. If you’re dealing with a child or adolescent that is currently self harming, here are some tips to help you navigate this problem:

1. Don’t panic or punish your child for self-injury. As we said before, many individuals how self injure tend to do so to feel something other than a flat affect or numbness. Yelling at your child or panicking because they are self injuring often causes a child to retreat further in to themselves to the point where they may not want to disclose anything to you.

1. Don’t be afraid to have hard conversations with your kids about their self injury. There are instances when cutting can be a sign that your child or teen wants help. It is important to listen to what they are saying through their behavior, and also be willing to talk to them about what is really going on. Be mindful of their reactions as well as understand that your child may disclose something about you that you may not want to hear. However, if you let your child know that you will do your part as a parent to help change the situation, your child may end up being willing to open up to you more.

1. Be sure to put everything that your child could use to injure themselves out of their reach. If your child is self injuring it is important to ensure their safety first and foremost. This may mean that you have to do weekly room checks or check to see if any new injuries are coming up on them physically. This may also mean that you have to put away things that you use on a daily basis (i.e. knifes, razor blades, curling irons, etc.).

1. Work with your child to put together a plan of action for when they feel like cutting. Many children or teens don’t know how to effectively cope with painful feelings so they resort to cutting or other maladaptive behaviors. Having a coping plan of action helps build up the necessary skills that children need in order to adapt fully and in a healthy way to a difficult situation. This may mean, mom and dad, that you as a family have to get creative with coming up with skills that your child can practice. It also may be helpful to put together a list of skills and strategies up in your child’s room in order to help them remember what skills they agreed to.

While self injury may be a difficult problem to navigate, it is still possible to walk through it and come out the other side a little bit wiser. The key to navigating this problem is being willing to help your child or your family member who self injures find a way to express their emotions as well as allows them to feel their emotions in a healthy and genuine way.

For many of us, the past 2-3 weeks have been anything but normal. With the COVID-19 virus on the rise, and local government rules and regulations changing daily, it is no surprise that most of us are experiencing higher levels of stress and anxiety. Many of us have been mandated to work from home, our children’s schools have closed, we’ve been told to practice social distancing, and certain foods and household products have become scarce. These, along with a slew of other concerns have found their way into our daily life and threatened to jeopardize our mental health.

One way to help offset these higher levels of stress and anxiety, is to practice meditation. According to liveanddare.com, meditation is a mental exercise that involves relaxation, focus, and awareness. Meditation can be done individually or in a group setting. And while it is important to set aside time for self-care, getting your family involved could potentially provide them with some much needed de-stressing along with some family time. In addition, several benefits of meditation include reduction in depression, stress, anxiety, and it even assists with mood regulation, and building resilience, according to positivepsychology.com. In children, meditation can help boost self-esteem, motivation, develop empathy, and improve attention span. There is no need to overthink or spend a lot of time preparing; just find a comfortable spot if practicing individually, or an ample space in your home to fit your family. Begin by finding a comfortable place to sit, close your eyes, and make sure to focus on your breathing. If you’re just starting out, begin by meditating for 5 minutes at a time. Then, gradually increase that time to 10 minutes, and then 15 minutes. I suggest utilizing a meditation app or any of the available videos on YouTube, to practice guided meditation. Many of the videos and apps have the option of incorporating music, which for some helps them keep focused and relaxed during the process. There are even videos specifically for children that any parent can enjoy and participate in.

With so many different variations, and the encouragement to make meditating your own, it’s no surprise why many individuals incorporate it into their daily routine.

Helpful Links to get you started:

How to Meditate

1. What are you most grateful for?

2. What are you most looking forward to this week?

3. How do you feel about things changing?

4. What color best describes how you’re feeling today? More than one color?

5. What are the most interesting things about you?

6. What animals would we all be and why?

7. If you were a superhero, what would your power be and what would you be called?

8. What scares you and why?

9. What are you most proud of?

10. Miracle Question: “Imagine that while you were sleeping tonight a miracle happened. While you slept, ______________ (insert problem here) mysteriously disappeared. When you got out of bed the next morning, what would be the first thing you noticed that would clue you in that a miracle had happened?

Written by: Valerie Perez, Doctoral Intern

Given the melting pot that makes up the United States, one of the qualities that psychologists are striving to obtain is the ability to be culturally competent. It is crucial now more than ever to be able to work with individuals that come from different backgrounds and still be able to provide an effective service.

Discrimination in the past has caused divides amongst many groups based on gender, race and religion. In the most recent past, individuals that identify as part of the LGBT community have also been at risk to endure the backlash, homophobia and othering that is felt with minority groups. It is my hope that these individuals are afforded the same safe space in the mental healthcare world as any other individual seeking help. Some things that these individuals may find helpful in therapy is having their therapist be proactive in LGBT education as well as implementing the correct use of pronouns in a session. For example, for transmen, the use of “he, him or sir,” (or whichever pronoun they identify with) can go a long way to build a strong therapeutic alliance.

Other suggestions are to refrain from asking questions out of curiosity and rid the assumption that the cause of their stress or trouble is somehow related to their sexuality or gender identity. Magnifying their sexuality as the main topic of conversation has the potential to negatively impact the alliance and pathologize a nuance that may or may not be an issue for them. Therapists are a beacon of hope, safety and change and we are doing a disservice to our LGBT clients when we act counterproductively. It is truly amazing how the little things we do in our conversations can make the world of difference in the therapeutic experience. So, what are therapists to do that do not share the same views as their clients? How are they to navigate these situations where their moral values clash with their ethical obligations to their clients? This has been a controversial question that has seemed to make its way up into the legal realm and has changed the language of policies across the states.

In my personal opinion, the answer is simple: treat that client no differently than any other human sitting in the chair in front of you, for it is an inevitable truth that we dive into lives that will always be different than our own. It is in these idiosyncrasies that they find their strengths and embrace the comfort of being unapologetically themselves. Ultimately, we must take care of the unique privilege we are granted as psychologists to be allowed into a person’s deepest vulnerabilities

During these uncertain times, it is especially important to practice introspection and utilize the resources around us. For some, this might come naturally and easy and for others the thought of a broken routine has jolted the world into chaos. Nothing makes sense, tension is up and social distancing has turned into a punishment. Usually, during times of crisis we urge individuals to go visit their local mental health centers and work through the problems with a team of professionals. Well, it was only during a pandemic that we have been able to see the privilege we are afforded by physically being present with a therapist. This transition to tele-health has brought forth a plethora of new experiences and logistical considerations.

Mental health professionals have had to collectively shift their clinical structure onto online platforms in order to continue serving their clients. The one platform I want to highlight is the use of a national crisis text line. This support line is used to serve anyone in the United States experiencing a crisis through a text message medium. Understandably, this text line has seen an increase in texters reaching out for help with covid-19-related concerns. In one of their recent blogs tracking the makeup of their texters as well as the different coping strategies they have found themselves doing during self-isolation. For example, more 18-34 and 44-55-year-olds have been reaching out for help after the influx of covid-19 repercussions. Even though this is expected to happen due to the limitations set out on how we are allowed to interact, crisis text line volunteers have ramped up their outreach and have been fighting hard on the mental health frontlines.

Despite these higher than normal numbers, individuals going through this isolation alone have found themselves sleeping, doing yoga and eating fruits and vegetables more often than their non-single counterparts. This speaks volumes about the strength these individuals have during tough times and the resources they use to get them through. Individuals have had to adjust their normal self-care routines and adapt to the space they find themselves in during quarantine. Others have had to reflect on the importance of priorities and learn new habits to keep themselves going. Regardless, it is important to keep in mind that everyone’s mental strength is different and it is up to us to check-in on our loved ones and support other’s concerns. Each day is experienced differently and each is considered valid. These difficult days reveal the courage we have and the power we have when we work as one.

Lublin, N. (2020, April 2). Notes on Coronavirus: How is America Feeling? Part 3. Crisis Text Line. https://www.crisistextline.org/data/notes-on-coronavirus-how-is-america-feeling-part-

As a therapist we hear lots of different things throughout our day. We don’t always hear “the best” of things in peoples lives. One thing that has always struck me though is when people will say “I don’t want people to think I’m crazy” or “I feel so bad being in counseling.” These statements strike me because here we are in the year of 2020 and mental health has made small steps forward in breaking the old thought pattern that “only crazy people go to counseling” or that “there has to be something very wrong with me to be in counseling.”

Counseling is not a sign of weakness, in fact, going to counseling and talking with an unbiased person is very healthy and a beneficial activity one can engage in. Yes, many times people enter into counseling for symptoms related to depression or anxiety, but also, individuals will seek out counseling to help with other aspects of their lives.

Learning to express your emotions and feelings in a healthy way has significant benefits for an individual. Individuals are not always taught healthy ways to express and deal with their emotions. Males, in particular, are not always taught that emotions and feelings are natural, many times they are taught to not to have emotions or feelings, or that the only ‘manly’ emotions to have is anger. Male clients can learn to express their emotions and feelings in a healthy manner. When an individual learns how to effectively express and manage their emotions individuals can feel build lasting relationships with others, it helps to reduce tension in the body, and improves your physical and mental health.

Individuals can also benefit from in counseling to gain an outsider’s perspective on issues. Sometimes we turn to friends or loved ones for guidance and opinions on what to do with problems that we are facing. While the intent from those individuals is good, sometimes a perspective from an unbiased individual provides a deeper understanding of the problem, we can gain a different perspective of how to resolve the problem, and one can gain a deeper understanding of repeated thinking errors that one engages in that can lead to repeated unhealthy behaviors.

Individuals can also gain coping skills for emotions or feelings that they struggle with. When an individual learns how to effectively manage their emotions and feelings, in particular, negative emotions and feelings like depression and anxiety on their own, individuals can gain a sense of confidence in themselves that can spill into other areas of one’s life. When someone learns how to effectively manage their emotions in a healthy way, they become more present in their life. They are able to laugh and enjoy time with their loved ones. They can be present at work and more productive.

Many times, couples come to counseling because of a problem that they can’t fix, but counseling can also be an effective tool before problems arise. Couples can learn how to communicate in a health manner, leading to a healthier and more fulfilled relationship. Couples can gain skills that allows each individual to communicate their needs, learn how to get their needs met, and in turn lead to a healthier more fulfilled relationship. Couples can also gain skills to argue in an effective way. Arguing is a natural event in relationships but learning to argue in a way that promotes growth is a skill that couples can obtain through counseling.

Counseling is an effective way to improve you as an individual or an effective activity couples can engage in to make their relationship stronger and more rewarding. Learning to think of counseling as activity to improve your overall health is an effective way of breaking the negative stigma counseling has. Counseling and therapy is no longer for individuals with something “wrong” but an activity that helps promote a healthy lifestyle just like going to the gym or going to the doctor for a yearly checkup.